Evaluating the Feasibility and Usability of the Disposable Intubation Drape (I-Drape).

In response to the COVID-19 pandemic, several protective barrier enclosures were developed to protect healthcare providers during airway manipulation. A certified registered nurse anesthetist (CRNA) created a barrier, the disposable intubation drape (I-Drape), that addressed limitations in range of motion. A nonrandomized, quasi-experimental design with repeated measures was used to evaluate I-Drape usability. CRNAs implemented I-Drape up to three times. Multilevel modeling was used to analyze the primary outcome: time (in seconds) to successful intubation. An online survey was used to evaluate secondary outcomes of interest: users' perceptions of features such as usability, visibility, and durability. We recruited 23 CRNAs as participants for 59 trials. Overall successful intubation and first-pass success rates were 96.6% and 93.2%, respectively. Time to successful intubation did not significantly decrease (ß = -9.16, P = 0.323) or differ significantly among types of laryngoscopy device and years of experience was not a significant factor. Overall, users favorably rated I-Drape with respect to usability, visibility, durability, and feature utility. This study demonstrated the functionality, success rate, and acceptability of I-Drape. I-Drape can be used safely and efficiently with any type of laryngoscopy device by providers with various experience levels.

Portable Biosafety Barrier Innovations to Limit Transmissibility of Infectious Diseases during Patient Care in Resource-limited Settings during the COVID-19 Pandemic.

Background: The coronavirus disease-2019 (COVID-19) pandemic has brought about a change in healthcare practices that are likely to persist into the foreseeable future. In particular, is the exposure risk to the healthcare practitioners in the emergency department (ED) and the intensive care units. Mitigating this issue in a low-resource setting remains challenging, and in particular, in developing nations such as India, where ED patient flows can overwhelm a system and its human resources, breaking down processes and infecting healthcare workers (HCWs). Technique: To tackle this and the possible lack of appropriate personal protective equipment (PPE), we designed and built biosafety barrier devices using local resources for use in patient stabilization, transport, and continued care in the ED or the intensive care units. Results: Four biosafety devices bio-safe levels 1 and 2, ultra-ductile portable interface of interventions in infections, and tented transport trolley for transmissibility (4T) were tested for the feasibility of usage for patient care during the pandemic with simulation. Conclusion: We anticipate that with time it may be common practice for in situ isolation of patients in the emergency departments with a suspicion of an infectious disease. With the proof of concept, simulation, hospital infection control committee (HICC) approval, and trial run, we look to close the gaps that exist in these initial innovations. How to cite this article: Balakrishnan JM, Sirur FM, Prakash N, Bhat R, Wilson W, Angadi B, et al. Portable Biosafety Barrier Innovations to Limit Transmissibility of Infectious Diseases during Patient Care in Resource-limited Settings during the COVID-19 Pandemic. Indian J Crit Care Med 2022;26(9):1036-1038.

Video-Assisted Stylet Intubation with a Plastic Sheet Barrier, a Safe and Simple Technique for Tracheal Intubation of COVID-19 Patients.

As the COVID-19 pandemic evolves, infection with the Omicron variants has become a serious risk to global public health. Anesthesia providers are often called upon for endotracheal intubations for COVID patients. Expedite and safe intubation can save patient's life, while minimizing the virus exposure to the anesthesia provider and personnel involved during airway intervention is very important to protect healthcare workers and conserve the medical work force. In this paper, we share clinical experience of using a video-assisted intubating stylet technique combined with a simple plastic sheet barrier placed over the patients' mouth for tracheal intubation during the Omicron crisis in Taiwan. We demonstrated that the use of an intubating stylet combined with plastic sheet barrier is swift, safe, and accurate in securing the airway in patients with COVID-19.

Simulation and evaluation of the protective barrier enclosure for cardiopulmonary resuscitation.

INTRODUCTION: The COVID-19 pandemic has presented a significant challenge for infection prevention and control during airway management in anaesthesia and critical care. The protective barrier enclosure has been described and studied particularly for perioperative anaesthesia use. The potential use of the protective barrier enclosure during cardiopulmonary resuscitation has been poorly explored in the current literature. This work aims to demonstrate the potential of protective barrier enclosure in limiting aerosol dispersion during cardiopulmonary resuscitation delivery. METHODS: A proof-of-concept simulation study was conducted to evaluate the protective properties of the protective barrier enclosure during cardiopulmonary resuscitation. Aerosol was simulated using a fluorescent dye trapped within the manikin. Three different methods of cardiopulmonary resuscitation delivery with a protective barrier enclosure applied over the manikin's head were conducted. The first method simulated a chest compression only cardiopulmonary resuscitation, the second method also used chest compressions only, with a face mask fitted on the victim, while the third method, the victim was given chest compression and bag-valve-mask ventilation by two rescuers. RESULTS: In the first method, release of aerosol from the manikin's mouth was observed during chest compression, while in second method, most of the aerosol was trapped within the face mask, with only minor leaking. However, when bag-valve-mask ventilation was delivered, the aerosol leaked out at high speed around the bag-valve-mask seal. No aerosol condensation was found outside of the protective barrier enclosure in all scenes. CONCLUSION: Protective barrier enclosure may reduce aerosol exposure to the rescuers during out-of-hospital cardiac arrest.

The impact of a barrier enclosure on time to tracheal intubation: a randomized controlled trial.

PURPOSE: Novel devices such as the barrier enclosure were developed in hopes of improving provider safety by limiting SARS-CoV-2 transmission during tracheal intubation. Nevertheless, concerns arose regarding a lack of rigorous efficacy and safety data for these devices. We conducted a randomized controlled trial to evaluate the impact of the barrier enclosure on time to tracheal intubation. METHOD: After Research Ethics Board approval, elective surgical patients with normal airway predictors were randomly allocated 1:1 to tracheal intubation with or without a barrier enclosure. The primary outcome was time to tracheal intubation. Secondary outcomes included first-pass success rate, total time of airway manipulation, anesthesiologists' perception of intubation difficulty, likelihood of use in SARS-CoV-2-positive patients, and patients' perception of comfort and acceptability. RESULTS: There were 48 participants in the barrier enclosure group and 46 participants in the control group. The mean (standard deviation [SD]) time to tracheal intubation was 62 (29) sec with barrier closure and 53 (27) sec without barrier enclosure (mean difference, 9 sec; 95% confidence interval, - 3 to 20; P = 0.14). Anesthesiologists rated the difficulty of intubation higher with barrier enclosure (mean [SD] visual analogue scale score, 27 [26] mm vs 9 [17] mm; P < 0.001). There were no significant differences in other secondary outcomes. CONCLUSION: In healthy surgical patients with normal airway predictors, the use of a barrier enclosure during tracheal intubation did not significantly prolong time to intubation or decrease first-pass intubation success. Nevertheless, there was an increase in difficulty of intubation perceived by the anesthesiologists with use of a barrier enclosure. TRIAL REGISTRATION: www.clinicaltrials.gov (NCT04366141); registered 28 April 2020.

RéSUMé: OBJECTIF: De nouveaux dispositifs tels que des boîtes de protection ont été mis au point dans l'espoir d'améliorer la sécurité des fournisseurs de soins en limitant la transmission du SRAS-CoV-2 pendant l'intubation endotrachéale. Néanmoins, des inquiétudes ont été soulevées au sujet d'un manque de données rigoureuses sur l'efficacité et l'innocuité de ces dispositifs. Nous avons réalisé une étude randomisée contrôlée afin d'évaluer l'impact d'une boîte de protection sur le temps de l'intubation endotrachéale. MéTHODE: Après avoir reçu l'approbation du Comité d'éthique de la recherche, des patients de chirurgie élective présentant des prédicteurs des voies aériennes normales ont été aléatoirement répartis à un ratio de 1:1 pour une intubation endotrachéale avec ou sans boîte de protection. Le critère d'évaluation principal était le temps nécessaire à l'intubation endotrachéale. Les critères d'évaluation secondaires comprenaient le taux de réussite à la première tentative, le temps total de manipulation des voies aériennes, la perception par les anesthésiologistes de la difficulté d'intubation, la probabilité d'utilisation chez les patients atteints du SRAS-CoV-2, et la perception de confort et d'acceptabilité des patients. RéSULTATS: Il y avait 48 participants dans le groupe avec boîte et 46 participants dans le groupe témoin. Le temps moyen (écart type [ÉT]) pour l'intubation endotrachéale était de 62 (29) sec avec la boîte et de 53 (27) sec sans la boîte (différence moyenne, 9 sec; intervalle de confiance de 95 %, − 3 à 20; P = 0,14). Les anesthésiologistes ont estimé que la difficulté d'intubation était plus élevée avec une boîte de protection (score moyen sur l'échelle visuelle analogique [ÉT], 27 [26] mm vs 9 [17] mm; P < 0,001). Il n'y avait pas de différences pour les autres critères d'évaluation secondaires. CONCLUSION: Chez les patients chirurgicaux en bonne santé avec des prédicteurs de voies aériennes normales, l'utilisation d'une boîte de protection pendant l'intubation endotrachéale n'a pas prolongé de manière significative le temps d'intubation ni réduit le taux de réussite de l'intubation à la première tentative. Néanmoins, il y avait une augmentation de la difficulté d'intubation perçue par les anesthésiologistes avec l'utilisation d'une boîte de protection. ENREGISTREMENT DE L'éTUDE: www.clinicaltrials.gov (NCT04366141); enregistrée le 28 avril 2020.

Effective design of barrier enclosure to contain aerosol emissions from COVID-19 patients.

Facing shortages of personal protective equipment, some clinicians have advocated the use of barrier enclosures (typically mounted over the head, with and without suction) to contain aerosol emissions from coronavirus disease 2019 (COVID-19) patients. There is, however, little evidence for its usefulness. To test the effectiveness of such a device, we built a manikin that can expire micron-sized aerosols at flow rates close to physiological conditions. We then placed the manikin inside the enclosure and used a laser sheet to visualize the aerosol leaking out. We show that with sufficient suction, it is possible to effectively contain aerosol from the manikin, reducing aerosol exposure outside the enclosure by 99%. In contrast, a passive barrier without suction only reduces aerosol exposure by 60%.

Barrier enclosure use during aerosol-generating medical procedures: A scoping review.

INTRODUCTION: Barrier enclosure devices were introduced to protect against infectious disease transmission during aerosol generating medical procedures (AGMP). Recent discussion in the medical community has led to new designs and adoption despite limited evidence. A scoping review was conducted to characterize devices being used and their performance. METHODS: We conducted a scoping review of formal databases (MEDLINE, Embase, Cochrane Database of Systematic Reviews, CENTRAL, Scopus), grey literature, and hand-searched relevant journals. Forward and reverse citation searching was completed on included articles. Article/full-text screening and data extraction was performed by two independent reviewers. Studies were categorized by publication type, device category, intended medical use, and outcomes (efficacy - ability to contain particles; efficiency - time to complete AGMP; and usability - user experience). RESULTS: Searches identified 6489 studies and 123 met criteria for inclusion (k = 0.81 title/abstract, k = 0.77 full-text). Most articles were published in 2020 (98%, n = 120) as letters/commentaries (58%, n = 71). Box systems represented 42% (n = 52) of systems described, while plastic sheet systems accounted for 54% (n = 66). The majority were used for airway management (67%, n = 83). Only half of articles described outcome measures (54%, n = 67); 82% (n = 55) reporting efficacy, 39% (n = 26) on usability, and 15% (n = 10) on efficiency. Efficacy of devices in containing aerosols was limited and frequently dependent on use of suction devices. CONCLUSIONS: While use of various barrier enclosure devices has become widespread during this pandemic, objective data of efficacy, efficiency, and usability is limited. Further controlled studies are required before adoption into routine clinical practice.

Use of Disposable Clear Plastic Elastic Band-Rimmed Bag to Limit Infectious Aerosol during Airway Instrumentation.

The coronavirus disease 2019 (COVID-19) pandemic has highlighted the need for appropriate protective measures for health care providers, particularly for those involved in aerosol-generating procedures. We report the use of the banded bag for extubation to contain infectious aerosols. The banded bag is a clear and disposable shower-cap style image intensifier cover which is commonly used as a sterile cover for mobile X-ray systems. With the addition of a filtered suction, safe air exchange rates can be obtained. We anticipate that the banded bag, which is economical, convenient, and highly practical, can be used as a safety-enhancing device for COVID-19 extubations.

A novel protective barrier enclosure for performing bronchoscopy.

Healthcare workers performing bronchoscopy, especially in urgent cases, may be at risk of aerosol-transmitted infection with severe acute respiratory syndrome coronavirus 2. Therefore, such healthcare workers require thorough protection from aerosol droplets. To this end, we developed a novel handmade protective barrier enclosure for performing flexible bronchoscopy. The use of this enclosure did not entail any special technique for handling the bronchoscope during bronchoscopy. The enclosure may be helpful in protecting bronchoscopists from the risk of aerosol-transmitted infections, including coronavirus disease 2019.